Breast – practical
Dr: Salah Ahmed
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Acute mastitis :
- occurs during lactation (cracks and fissures in nipple)
- acute inflammation, may progress to abscess
- painful swollen breast , fever
- treated with antibiotic, milk drainage, surgical (abscess)
• Periductal mastitis : (recurrent subareolar abscess)
- occurs in women and men, associated with smoking
- squamous metaplasia in large ducts (vit A deficiency), keratin within ducts leads to
their dilatation and rupture, chronic granulomatous inflammation and fibrosis
- painful subareolar mass
- complicated by fistula opens at edges of areola
- treated by removal of involved duct and fistula
Strong association (>90%) with smoking – chronic
Granulomatous response to keratin
• Ductectesia :
- dilatation of ducts with surrounding chronic inflammation
- occurs in 5th, 6th decades, usually in multiparous
- poorly defined mass and thick white nipple discharge
- treated by surgical removal
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Fat necrosis :
- trauma, surgery, radiation
- necrotic fat cells surrounded by macrophages, lymphocytes and foreign body giant
cells
- painless mass , skin thickening
- treated by surgical removal
• Lymphocytic mastopathy
- common in women with type I DM and autoimmune thyroiditis ( ? Autoimmune disease
- fibrous stroma with prominent lymphocytic infiltration
- single or multiple hard masses, may be bilateral
- No tissue obtained in FNA
• Granulomatous mastitis :
- it is rare
- infection (tuberculosis, fungal)
- 2dary to systemic granulomatous diseases (Sarcoidosis )
Fibrocystic disease
Pathogenesis:
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Estrogen & Progesterone
– Estrogen predominance over progesterone is considered causative
Prolactin– levels are increased in 1/3 of women with FCC
Thyroid –
– sensitize mammary epithelium to Prolactin stimulation
Methylexanthiones– Increased intake of coffee, tea, cold drinks chocolate is associated with
development of FCC
• Nonproliferative change :
- are not associated with risk of breast cancer
- 3 patterns : 1- cyst
2- fibrosis
3- adenosis
1) Cysts :
- formed by dilatation of lobules
- may cause breast lumpness, nipple discharge
2) Fibrosis :
- cysts frequently ruptured, release their content into stroma leads to chronic
inflammation and fibrosis
3) Adenosis :
- is an increase in the number of acini (tubules) per lobule
- either : - physiological, during pregnancy, as diffuse change
- pathological , in nonpregnant , as focal change
C
A
F
FCC
Adenosis
Cyst
Fibrosis
• Proliferative change without atypia :
- characterized by proliferation of ducts and lobules epithelium and or stroma without
atypia
1) epithelial hyperplasia
2) sclerosing adenosis ( adenosis with dense fibrous stroma ,
mistaken for cancer )
3) Intraductal papilloma :
- occurs in large lactiferous ducts
- clinically may cause serous or bloody discharge
• Proliferative change with atypia :
- includes atypical ductal hyperplasia (ADH) and atypical lobular hyperplasia (ALH)
- ADH is more common than ALH
- both predispose to carcinoma
Diagnosis: 1- mammography 2- ultrasonography 3- FNA
Epithelial hyperplasia, sclerosing adenosis
Intraductal papilloma
FNA
01/07/2016
Fibrocystic Breast Disease - Prof.S.N.Panda
15
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Fibroadenoma :
- is the most common benign breast tumor
- firm, white-gray
- cellular stroma enclosing acini or glands
- two types : 1- intracanalicular fibroadenoma : stroma
compresses and distorts glands into slit-like spaces
2- pericanalicular fibroadenoma : glands retain
round shape
• Phyllodes : (giant fibroadenoma ) - it is uncommon
- rare before 40 years
- huge, lobulated mass
- cleft-like or cystic spaces lined by epithelium with cellular stroma
- Complete excision is curative (10% recurrence : incomplete excision)
- malignant change occurs in < 5% of cases (sarcoma
Thank you